Germ-line gene therapy and the clinical ethos of medical genetics

Although the ability to perform gene therapy in human germ-line cells is still hypothetical, the rate of progress in molecular and cell biology suggests that it will only be a matter of time before reliable clinical techniques will be within reach. Three sets of arguments are commonly advanced against developing those techniques, respectively pointing to the clinical risks, social dangers and better alternatives. In this paper we analyze those arguments from the perspective of the client-centered ethos that traditionally governs practice in medical genetics. This perspective clarifies the merits of these arguments for geneticists, and suggests useful new directions for the professional discussion of germ-line gene therapy. It suggests, for example, that the much discussed prospect of germ-line therapy in human pre-embryos may always be more problematic for medical genetics than adult germ-line interventions, even though the latter faces greater technical difficulties.     

Symptom patterns in late luteal-phase dysphoric disorder

The symptom patterns of 180 women with prospectively confirmed late luteal-phase dysphoric disorder (LLPDD) were examined using a careful application of factor and cluster analytic techniques. Factor analysis of premenstrual change scores on 33 common premenstrual syndrome symptoms yielded four orthogonal factors that were consistent across two sets of menstrual cycle data. These were a negative affect dimension with concomitant behavioral changes, physical symptoms, agitation, and positive arousal. Cluster analysis of factor scores grouped patients into one of five symptom patterns, the most common of which is a general distress cluster, characterized by symptoms across all dimensions. The LLPDD symptom groups identified are remarkably consistent with those of earlier studies using both normative and clinic samples, and consideration of symptom pattern differences in future research may greatly increase our understanding of this disorder.     

The menstrual distress questionnaire: Are the critics right?

The Menstrual Distress Questionnaire (MDQ) is the most widely used method of assessing premenstrual symptomatology. It is also the most frequently criticized instrument in this field. A review of the criticisms made toward the MDQ revealed three major issues concerning the reliability and validity of this instrument and the sample from whom normative data were gathered. These issues were examined in light of 49 studies that used this instrument between 1968 and 1990. Many of the criticisms were found to be justified. A marked lack of adequate research into the MDQ’s reliability, problems associated with the normative sample, and uncertain validity were found. In particular, the MDQ appears to measure constructs unrelated to the menstrual cycle and define premenstrual syndrome inaccurately. In addition, the factor structure of this instrument may be unstable. These conclusions were tempered with the knowledge that the MDQ has not been utilized to its full potential in most of the research conducted to date.     

Empathy as a hermeneutic practice

This essay will argue for the centrality of empathy in the doctor-patient relationship — as a core of ethically sound, responsible therapeutics. By “empathy,” I intend an explicitly hermeneutic practice, informed by a reflexive understanding of patient and self. After providing an overview of the history of the concept of empathy in clinical medicine, I discuss current definitions and the use of Balint groups in residency training as a way to develop empathic competence in novice physicians.     

Grandparents Raising Grandchildren

Children and youths are being raised by grandparents in greater numbers than would be expected by choice or by chance. These new households represent a transfer of child-rearing responsibilities from an absent or incapacitated parent to an older adult who could also be at risk for disability. This article discusses the implications of this trend for the helping professions, particularly as they apply to interventions required to assure the mental and physical stability of both grandparent and child.     

Generations Lost: A Cancer Genetics Case Report

The process of cancer genetic counseling can unearth issues that, sometimes unbeknownst to the counselor, are emotionally and psychologically significant to the patient. The following case report illustrates how the precounseling process of obtaining a medical chart on a deceased parent affected two sister counselees. This medical chart helped these sisters to reconnect with the mother they lost as children and to better understand her struggle with breast cancer. This case also chronicles the counselor's professional growth and discovery during this process.     

Optimum examinee samples for item parameter estimation in item response theory: A multi-objective programming approach

This paper proposes a multi-objective programming method for determining samples of examinees needed for estimating the parameters of a group of items. In the numerical experiments, optimum samples are compared to uniformly and normally distributed samples. The results show that the samples usually recommended in the literature are well suited for estimating the difficulty parameters. Furthermore, they are also adequate for estimating the discrimination parameters in the three-parameter model, butnot for the guessing parameters.     

University faculty gender roles perceptions

Gender role preferences for Ideal Woman and Ideal Man and perceptions of Most Women, Most Men and Self were surveyed in 400 faculty women and men, of which 83% were Caucasian, 9% Hispanic, 4% African-American, and 3% Asian. Both women and men faculty preferred an androgynous Ideal Woman, but a masculine Ideal Man. Similarly, faculty women described themselves as androgynous, while men described themselves as masculine. Both women and men perceive Most Women and Men as sex-typed. Women and men faculty preferences and perceptions were generally very similar.